15 research outputs found
Panethnic Differences in Blood Pressure in Europe: A Systematic Review and Meta-Analysis
BACKGROUND:
People of Sub Saharan Africa (SSA) and South Asians(SA) ethnic minorities living in Europe have higher risk of stroke than native Europeans(EU). Study objective is to provide an assessment of gender specific absolute differences in office systolic(SBP) and diastolic(DBP) blood pressure(BP) levels between SSA, SA, and EU.
METHODS AND FINDINGS:
We performed a systematic review and meta-analysis of observational studies conducted in Europe that examined BP in non-selected adult SSA, SA and EU subjects. Medline, PubMed, Embase, Web of Science, and Scopus were searched from their inception through January 31st 2015, for relevant articles. Outcome measures were mean SBP and DBP differences between minorities and EU, using a random effects model and tested for heterogeneity. Twenty-one studies involving 9,070 SSA, 18,421 SA, and 130,380 EU were included. Compared with EU, SSA had higher values of both SBP (3.38 mmHg, 95% CI 1.28 to 5.48 mmHg; and 6.00 mmHg, 95% CI 2.22 to 9.78 in men and women respectively) and DBP (3.29 mmHg, 95% CI 1.80 to 4.78; 5.35 mmHg, 95% CI 3.04 to 7.66). SA had lower SBP than EU(-4.57 mmHg, 95% CI -6.20 to -2.93; -2.97 mmHg, 95% CI -5.45 to -0.49) but similar DBP values. Meta-analysis by subgroup showed that SA originating from countries where Islam is the main religion had lower SBP and DBP values than EU. In multivariate meta-regression analyses, SBP difference between minorities and EU populations, was influenced by panethnicity and diabetes prevalence.
CONCLUSIONS:
1) The higher BP in SSA is maintained over decades, suggesting limited efficacy of prevention strategies in such group in Europe;2) The lower BP in Muslim populations suggests that yet untapped lifestyle and behavioral habits may reveal advantages towards the development of hypertension;3) The additive effect of diabetes, emphasizes the need of new strategies for the control of hypertension in groups at high prevalence of diabetes
Management Challenges Of Pediatric Infective Endocarditis At Tertiary Level In Rwanda
Background: Management of Infective Endocarditis (IE) has been of great
challenge for many years. Rapid diagnosis, effective treatment, and
prompt recognition of complications are essential to good patient
outcome as this condition is associated with a high morbidity and
mortality in both adults and pediatric patients. In limited resources
settings, management of IE is still a challenge due to early
inappropriate antibiotherapy and therefore difficulties in its
diagnosis and treatment. Objectives: To elicit challenges in management
of patients suspected of IE at tertiary level in Rwanda. Methods: We
report four patients with IE. For these patients, Duke’s criteria
were considered in making the diagnosis. Results and Conclusion: IE has
protean clinical symptoms and signs, and can be of challenging
diagnosis. The patients reported constituted a clinical challenge in
the diagnosis and management of IE but most of them had had favorable
outcome. The main clinical challenge was the prolonged stay to
peripheral settings with inappropriate antibiotherapy which made most
of the blood cultures falsely negative. Echocardiography and serial
blood cultures provide the key to diagnosis as per Dukes criteria.
Being alert to this mentioned challenge is crucial. As the key
investigations are not steadily available in most peripheral health
facilities, we strongly recommend early referral to tertiary level for
all cases of suspected IE before initiation of antibiotherapy.Introduction: Depuis plusieurs années, la prise en charge de
l’endocardite bactérienne constitue un grand défi.
Cette affection étant associée à une importante
morbidité et mortalité tant chez l’adulte que chez
l’enfant, un diagnostic rapide, un traitement efficace, et une
reconnaissance rapide de complications sont des éléments
essentiels pour arriver à un bon résultat thérapeutique.
Dans les pays où les ressources sont limitées, la prise en
charge de l’endocardite reste difficile en raison de
l’antibiothérapie inappropriée initiée
préalablement au niveau des structures sanitaires de base.
Objectif: Identifier les défis dans la prise en charge des
patients présentant une endocardite bactérienne au niveau des
structures sanitaires tertiaires du Rwanda. MĂ©thodes: Nous
rapportons quatre patients qui présentaient une endocardite
bactérienne. Pour tous ces patients, les critères de Duke ont
été utilisés pour poser le diagnostic. Résultats et
conclusion: L’endocardite infectieuse a des formes cliniques
variables et peut rendre le diagnostic difficile. Bien que presque tous
les patients reportés dans cette étude ont été
traités avec succès, leur prise en charge n’a pas
été facile d’emblée. Le plus grand défi a
été un séjour prolongé sous antibiothérapie
probabiliste a l’Hôpital de District, ce qui a rendu la
plupart des hémocultures faussement négatives au niveau
tertiaire. L’échocardiographie et une série d’au
moins 3 hémocultures constituent les éléments clés
des critères de Duke pour le diagnostic de l’endocardite
bactérienne. Par conséquent, il est crucial pour les
cliniciens de tenir compte de ces critères pour poser le
diagnostic d’endocardite. Compte tenu de l’absence de
moyens pour faire les hémocultures et une échocardiographie
au niveau des hĂ´pitaux de district, nous recommandons un transfert
rapide au niveau de l’hôpital de référence pour
tout cas suspect d’endocardite bactérienne avant
d’initier l’antibiothérapie
Limited internal shocks for atrial fibrillation refractory to external cardioversion
We investigated the feasibility and long-term results of low-energy internal defibrillation using a Limited number of shocks in patients with persistent atrial fibrillation resistant to external cardioversion. A relatively high number of shocks of lower energy are usually required in those cases and can be poorly tolerated. Methods and results: Twenty-five patients with persistent atrial fibrillation underwent internal defibrination, using biphasic R wave synchronous shocks between two catheters in the high right atrium and the coronary sinus. Conversion to sinus rhythm was obtained in all patients, with a median of two shocks. Early recurrence of atrial fibrillation (AF) occurred in eight cases (32%). Seven patients (41%) out of 17 discharged in sinus rhythm remained free of AF after a median follow-up of 8.9 months. Severe mitral insufficiency (P=0.05) and low left ventricle ejection fraction (P=0.002) were correlated with earlier recurrence. Amiodarone significantly favored (P=0.019) maintenance of sinus rhythm. Conclusion: Internal defibrillation using a limited number of shocks equal to or less than 30 Joules is effective in terminating refractory atrial fibrillation and could be more acceptable for patients. However, the recurrence rate remains high, particularly in patients with severe mitral insufficiency or poor ventricular function. Amiodarone delays recurrences of atrial fibrillation. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved
Patients With Noonan Syndrome Phenotype: Spectrum Of Clinical Features And Congenital Heart Defect
Mutations in components of the RAS-MAPK signaling pathway have been
reported to result in an expression of Noonan phenotype. This is
actually a wide-spectrum-phenotype shared by Noonan syndrome and its
clinically related disorders namely, the Cranio-facio-cutaneous (CFC)
syndrome, Costillo syndrome as well as LEOPARD syndrome. Patients with
Noonan Syndrome (NS) have mutations in PTPN11 gene in majority of
cases. Recently, mutations in SOS1, RAF1, MEK1 and KRAS genes have been
reported to cause NS as well. Objective: To report patients with a
Noonan phenotype followed in Rwandan University Teaching Hospitals, and
to show the importance of the clinical diagnosis and challenges of
making the diagnosis in resource limited settings where karyotype is
almost the only genetic investigation accessible. Patients and Methods:
Here we are reporting 5 patients, all with relevant NS symptoms, whose
morbidity is directly related to the severity of their congenital heart
disease. Van der burgt et al diagnostic criteria have been used for the
clinical diagnosis, karyotype studies have been performed to exclude
chromosomal aberration disorders and patients DNA extraction for
mutation studies have been obtained in some cases. Results and
Conclusion: we identified 5 patients with clinical features highly
suggestive of NS and all of them had a normal karyotype, this excluding
Turner syndrome, a clinically similar syndrome. As there are many as
yet discovered mutations causing NS and the famous PTPN11 mutation
being present only in 50% of cases, we maintain here that NS diagnosis
should be a clinical diagnosis. The morbidity and mortality of our
patients were directly correlated to the severity of their congenital
cardiac defect. In conclusion, early management of such patients is
highly recommended.Les mutations impliquant la voie de transduction RAS-MAPK ont
étaient reconnues identifiées comme causant un «
phénotype du syndrome Noonan ». Ceci est en effet un
phénotype de spectre très large, partagé entre le
syndrome de Noonan et d’autres conditions cliniquement semblable
notamment le syndrome Crânio-Facio-Cutané (CFC), le syndrome
de Costillo ainsi que le syndrome de LEOPARD. Les patients atteints du
syndrome de Noonan ont des mutations dans le gène PTPN11 dans la
majorité des cas. Récemment, les mutations impliquant les
gènes SOS1, RAF1, MEK1 et KRAS ont étaient
caractérisées comme étant aussi impliquées dans le
développement du syndrome de Noonan. Objectifs: rapporter des
patients atteints du syndrome de Noonan suivis dans nos hĂ´pitaux
universitaires et montrer l’importance du diagnostic clinique
ainsi que le défi à faire le diagnostique dans un contexte
où les ressources sont limitées, seul le karyotype étant
presque le test génétique accessible. Résultats et
Conclusion nous avons identifié 5 patients avec un tableau
clinique suggestif du syndrome de Noonan et chez qui le karyotype a
été normal, ceci excluant le syndrome de Turner qui mime la
clinique du syndrome de Noonan. Compte tenu du fait qu’il y a
beaucoup de mutations causant le syndrome de Noonan et les mutation du
gène PTPN11 n’étant présentes que dans 50% des
cas, nous plaidons pour l’importance du diagnostique clinique. La
morbidité et mortalité des patients signalés dans cette
revue étaient directement liées à la
sévérité de leurs cardiopathies congénitales. En
conclusion, une prise en charge précoce de tels patients devrait
être recommandée
Combined right linear and focal radiofrequency ablation improves control of refractory atrial fibrillation
Early balloon dilatation of the pulmonary valve in infants with tetralogy of Fallot. Risks and benefits.
BACKGROUND: Balloon dilatation, an established treatment for pulmonary valve stenosis, remains a controversial procedure in tetralogy of Fallot. METHODS AND RESULTS: Balloon dilatation of the pulmonary valve was performed in 19 infants with tetralogy of Fallot. Its effects on the severity of cyanosis, the growth of the pulmonary valve and pulmonary arteries, and the need for transannular patching were evaluated. Clinical, echographic, angiographic, hemodynamic, and operative data were analyzed. The procedure was safe in all, without significant complications. After balloon dilatation, systemic oxygen saturation increased from a mean value of 79% to 90%. This increase proved to be short-lasting in 4 patients, who required surgery before the age of 6 months. Balloon dilatation increased pulmonary annulus size in each case, from a mean value of 4.9 to 6.9 mm (P < .001). This gain in size remained stable over time, with a mean Z score of -4.8 SD before dilatation, -3.1 SD immediately after the procedure, and -2.7 SD at preoperative catheterization (P < .001). Pulmonary artery dimensions remained unchanged immediately after balloon dilatation but increased at follow-up from a Z score mean value of -2.5 to -0.06 SD and from -2.2 to 0.04 SD for right and left pulmonary arteries, respectively (P < .001). At the time of corrective surgery, the pulmonary annulus was considered large enough to avoid a transannular patch in 69% of the infants. This represented a 30% to 40% reduction in the need for a transannular patch compared with the incidence of transannular patch expected before balloon dilatation. CONCLUSIONS: Pulmonary valve dilatation in infants with tetralogy of Fallot is a relatively safe procedure and appears to produce adequate palliation in most patients. It allowed the growth of the pulmonary annulus and of the pulmonary arteries, resulting in a mean gain of 2 SD for those structures
Effective prevention of atrial fibrillation by continuous atrial overdrive pacing after coronary artery bypass surgery.
OBJECTIVES: The present study was aimed to evaluate the efficacy of a specific algorithm with continuous atrial dynamic overdrive pacing to prevent atrial fibrillation (AF) after coronary artery bypass graft (CABG) surgery. BACKGROUND: Atrial fibrillation occurs in 30% to 40% of patients after cardiac surgery with a peak incidence on the second day. It still represents a challenge for postoperative prevention and treatment and may have medical and cost implications. METHODS: Ninety-six consecutive patients undergoing CABG for severe coronary artery disease and in sinus rhythm without antiarrhythmic therapy on the second postoperative day were randomized to have or not 24 h of atrial pacing through temporary epicardial wires using a permanent dynamic overdrive algorithm. Holter ECGs recorded the same day in both groups were analyzed to detect AF occurrence. RESULTS: No difference was observed in baseline data between the two study groups, particularly for age, male gender, history of AF, ventricular function, severity of coronary artery disease, preoperative beta-adrenergic blocking agent therapy or P-wave duration. The incidence of AF was significantly lower (p = 0.036) in the paced group (10%) compared with control subjects (27%). Multivariate analysis showed AF incidence to increase with age (p = 0.051) but not in patients with pacing (p = 0.078). It decreased with a better left ventricular ejection fraction only in conjunction with atrial pacing (p = 0.018). CONCLUSIONS: We conclude that continuous atrial pacing with an algorithm for dynamic overdrive reduces significantly incidence of AF the second day after CABG surgery, particularly in patients with preserved left ventricular function